The only NHS children’s gender clinic in England will close its doors for good next week. The Tavistock and Portman NHS Foundation Trust’s Gender Identity Development Service (Gids) will be replaced, initially, by two new regional services offering a more therapeutic model of care. Puberty blockers will not be on offer.
As I have written in the New Statesman Easter Special issue, NHS services have been at a standstill for years, and the private sector has inevitably stepped into that void. Gids staff, who haven’t been given jobs in the new gender hubs, have moved to one provider in particular – Gender Plus. It’s run by the clinical psychologist Dr Aidan Kelly, who worked at Gids between 2016 and 2021. At least nine other Gids staff, or those who have provided endocrinology services connected to Gids, are working alongside him. The private service is predominantly aimed at the 16-25 age group and will prescribe hormones from the age of 16.
But this week legal proceedings will be launched which, if successful, could hamper Gender Plus’s business model and stop others hoping to gain approval for prescribing hormones to teenagers.
The psychotherapist Sue Evans, who was the first to raise concerns about Gids when she worked there in 2005, seeks to challenge the Care Quality Commission in the High Court over its decision to license the Gender Plus Hormone Clinic. Official papers, seen by the New Statesman, accuse the CQC of breaching its statutory duties under the Health and Social Care Act 2008: “The Claimant seeks to challenge the lawfulness of the decision of the CQC on or around 9 January 2024 to register… Gender Plus Hormone Clinic to carry out the legally regulated service of ‘Treatment of disease, disorder or injury’.”
“In 20 years of work, I don’t think I’ve ever met a child that in my professional opinion, clinically, I would have said they’re fine to go forward for this treatment pathway after six sessions,” Evans, who now works in private psychotherapy practice, told me. Evans also instigated judicial review proceedings against the Tavistock and Portman trust in 2019, arguing that children could not fully consent to treatment with puberty blockers.
This time it’s hormone treatment not puberty blockers that are the subject of litigation. “I believe that we need to continue to be cautious where children’s lives are concerned,” said Evans. “The kids that I meet – who are 16, 17 – so many of them are still struggling with all sorts of issues; they’re only just finding out who they are and their identity. And so I feel compelled to keep standing up.”
Evans’s new case argues that the CQC have agreed to regulate a treatment that has not been shown to be either safe or clinically effective. In bringing the legal action, Evans and another claimant – the parent of a 15-year-old who is seeking treatment with puberty blockers and hormones – hope to prevent private clinics prescribing to under-18s.
In October 2020, the National Institute for Health and Care Excellence (Nice) undertook a systematic review of the evidence relating to the use of “gender-affirming” hormones in the treatment of young people with gender dysphoria. It concluded: “Any potential benefits of gender-affirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria.” It found that studies examining the impact of these drugs on under-18s were poorly designed and “subject to bias”, producing findings of “very low certainty”.
The anonymous parent who is launching the legal action alongside Evans is currently involved in litigation in the family courts with her ex-husband, and has obtained an interim order forbidding their child to access hormone treatments outside the UK. The child is now seeking to explore treatment with Gender Plus. The company’s staff have said publicly that they would “definitely” assess 15-year-olds, so that they could start accessing medical treatment at 16.
Paul Conrathe, who is representing both Evans and the parent, described the CQC’s decision to grant Gender Plus’s licence as a “leap in the dark”. “As regulator, the CQC is responsible for ensuring the public and especially the vulnerable and children receive safe and effective medical treatment,” he told the New Statesman. “Concerns for this treatment are particularly serious given the irreversible lifelong consequences and that it is given to a vulnerable group of teenagers.”
In an unexpected development on Thursday 21 March, NHS England quietly announced that new youth gender services will provide masculinising and feminising hormones to children from “around their 16th birthday”. This is a departure from Gids policy, which stipulated that young people could only access hormones at 16 if they had been on puberty blockers for a year. It appears to be at odds with the cautious stance towards medical interventions – evidenced by its decision to no longer prescribe puberty blockers – which underpins the model of care these new hubs are planning to follow.
Somewhat surprisingly, NHS England’s announcement makes no mention of Nice’s 2020 systematic evidence review, instead citing three documents which informed the new policy. One of the three is more than a decade old, and two relate to the treatment of adults only.
In other places, the policy refers to guidelines and documents that no longer exist. For example, the policy states: “The provider must be compliant with the British Society for Paediatric Endocrinology and Diabetes, UK Standards for Paediatric Endocrinology (2010)”. That particular document was last updated in 2019.
Children who are experiencing “psychotic episode[s], drug addiction or self-harming” will be eligible for hormones, as long as the “associated difficulties… are not escalating”, the new policy says. There is no stipulation of how long a young person will have to be seen before being eligible for hormones, with the duration of assessment being “determined by the clinical team as relative to the needs of the individual”.
One safeguarding measure in place is that a team not directly involved with the individual seeking hormones will have to agree that the child is suitable and meets all relevant criteria.
Gender Plus argues that its approach to care is in line with best practice, as demonstrated by NHS England’s new policy.
Conrathe told the New Statesman that the new policy did not change the case being brought against the CQC, as he claimed there remained no robust evidence underpinning the treatment.
Defending its decision to grant registration to the Gender Plus Hormone Clinic, a CQC spokesperson said: “Best practice guidance for gender identity clinics was considered by internal specialist advisers during the registration assessment and the registration was granted subject to the condition that the regulated activity must not be delivered to service users under the age of 16.” The spokesperson added that the CQC had not yet inspected the private gender clinic. “We are not able to comment further on active legal proceedings.”
[See also: The case against therapy in schools]
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